Table 7.

Infrastructure interventions for patient flow improvement

Main Category: Physical Infrastructure Interventions		Phases
		Pre-ED	Within-ED Ward	Post-ED
Generic Category	Subcategories/Examples			Ward	Home	Residential care
Buildings and structures	Buildings
	- Acute Medical Units (AMU) for community inpatient care [27]	+
	- Acute care unit within ED to receive patients who need inpatient services from the ED [30]		+	+
	- Establishing the adjacent/colocated primary care clinic for lower acuity patients [69]	NR			NR
	- Rapid assessment zones for expedited patient evaluation and treatment [7, 13, 27, 30]		±
	- Short Stay Units (SSUs) for streamlined ED patient care [7, 13, 27, 30]		±	±
	- Alternative Free Standing Emergency Departments (FSEDs) [58]	NR
	- Opening additional EDs [75]		NR
	- Implementing GP-led walk-in centres and colocating GPs [57]	=			=
	Physical structures
	- Increasing the numbers of beds or freeing beds [13, 34, 72, 75]	±	±
	- Reclining hospital chair [32]		+
	- Increasing the size of EDs [13, 34]		=
	- Hallway emergency bed policy (reorganisation of internal spaces for first patient evaluation using hallway beds/chairs) [72, 75]		±
	- Provision of patient lounges to support admission-discharge patient flow (Transit lounges) [34]		+	+
	- Allocating financial resources for patient flow enhancement [34]	NR	NR	NR	NR
Technology/Innovation	Telehealth
	- Telemedicine triage/Online ‘pre-ED’ triaging [13, 64]	±
	- Telehealth care service/virtual care/visit systems [13, 35, 65, 71]	±			±
Technology/Innovation	Information Technology (IT)
	- Clinical Decision Support Systems (CDSS) [29, 30, 65, 73]		NR			NR
	- Web-based dashboards and reporting applications to provide real-time information and monitor patient flow [29, 73, 75]		NR	NR
	- Implementing community-based Regional Transfer Network System (RTNS) [75]		+	+
	- Using capacity alert escalation call [75]		+	+
	- Mobile Devices [30]		NR
	- Computerised Provider Order Entry (CPOE) [7, 35, 64]		±	±
	- Integrated ED Information System [35]		NR
	- Implementation of simulation and predictive models/Discrete event simulation (DES)/predictive tool [29, 30, 35, 72, 73, 75]		NR	NR
	- Electronic board tracking/electronic patient tracking systems/electronic Blockage System (EBS) [7, 15, 34, 35, 64, 75]		+	+
	- Leverage machine algorithm learning [29, 73]		NR	NR
	- AI-powered automatic patient‒physician assignment [64]		NR
	- Implementing a random monitoring system of the ambulance block [72]	NR	NR
	- Telephone consultations [65]					NR
	- SMS reminder to consultant/residents about consultation delays [15, 31, 78]		NR
	- Use of instant messaging (e.g., WhatsApp) for real-time communication between ED physicians and consultants [78]		+
	- Electronic Health Records (EHR) Access [30, 60, 64, 72]		NR

 + : Outcomes of interventions: ( +): Positive outcome; (-): Negative outcome; ( ±): Mixed outcome/Conflicting evidence; ( =): Nonsignificant outcome/No difference

(NR) Not reported/Limited evidence